Fertility treatments are expensive, prohibitively so for most people. Luckily, there’s been an upswing in employer-sponsored insurance plans that cover at least some of the cost. According to the International Foundation of Employee Benefit Plans, 40% of US organizations currently offer fertility benefits, compared to 30% in 2020. Understanding your options and how to navigate fertility insurance can be helpful.
Does Insurance Help with Fertility?
Some private insurance plans may cover diagnostic infertility services, but they rarely cover the cost of fertility treatments like Intrauterine Insemination (IUI), in-vitro fertilization (IVF) or surrogacy. As of 2024, 21 states and Washington, D.C., have laws requiring some level of coverage for fertility services under certain conditions. Typically, the insurer must be based in the state to be obligated to offer this coverage.
However, the mandated level of coverage varies significantly from state to state. For example, California requires employers with over 100 employees to cover infertility diagnosis and treatment, including IVF. Conversely, in Texas, insurers are only required to offer IVF coverage to organizations with more than 100 workers. They do not have to cover the costs. Be sure to contact your plan administrator to check if your private insurance covers fertility services.
The Basics of Fertility Insurance Coverage
Most insurance plans cover diagnostic testing for infertility, but it's important to understand the specifics of your coverage.
- Diagnosing Infertility: If your plan covers the diagnosis, that generally means your plan will cover any tests and appointments performed as part of the diagnostic process.
- Up to Diagnosis: Your insurance might only cover the first visit, regardless of how many additional visits the full diagnostic process may require.
What is the Coverage for Fertility Treatment?
Beyond covering the diagnostic process, your insurance may pay benefits for fertility treatments, though it is less common. When coverage is available for treatments like IUI or IVF, it often comes with limitations, such as a cap on the number of attempts or a maximum amount the policy will cover. Some plans may also require you to meet specific qualifications or exclude coverage for certain situations, like prior sterilization.
What if Infertility is Caused by Another Underlying Medical Condition?
About 10-15% of heterosexual couples experience infertility for several reasons. Hormonal imbalances and reproductive conditions like PCOS and endometriosis have been linked to increased infertility. About 70-80% of women with PCOS will experience some form of infertility. Many insurers will cover the treatment of conditions such as PCOS, uterine fibroids, and endometriosis. In that case, you technically have infertility treatment coverage, though the coverage will generally only include medication and services related to the underlying condition.
Understanding Fertility Insurance Coverage
If you have the option to choose your insurance or different levels of coverage at your organization, it’s worth comparing fertility coverage. Here are some things to consider.
Treatments Offered
Does the plan only cover diagnostic services? Or will it also cover medications, genetic testing, and fertility preservation services like egg retrieval and storage?
Providers in the Network
If the insurer covers fertility treatments, is your chosen provider in-network? Do you have to go to a hospital, or can you use a fertility clinic?
Limits, Copays and Deductibles
Check for limitations on the number of rounds or attempts allowed for a specific procedure. While some plans may cover multiple cycles, there can be restrictions. Additionally, be aware of plan limits, copays, and deductibles. Many plans require you to meet a deductible before fertility benefits take effect. Evaluating the copays and coinsurance for fertility services is essential to understand your potential out-of-pocket costs. Some workplace plans may also have a maximum dollar limit on how much they will cover for fertility treatments, so be sure you thoroughly review your policy details.
Checking What Benefits you May Have
Check with your current insurer to see if you have any benefits. Remember that even if you have insurance, you may still have to meet an annual deductible or be subject to lifetime benefit maximums. The following are some questions you may want to ask when researching your coverage:
- Does the plan cover the costs of the diagnostic process, such as labs and appointments?
- Does my plan cover fertility treatments? If so, which ones?
- Do I need prior authorizations to access services?
- Is there a lifetime maximum number of cycles or procedures allowed?
- Is my preferred clinic in-network?
FAQs
Is Fertility Insurance Expensive?
If your insurer covers fertility treatments, they will set the monthly premiums and co-pays/co-benefits. If you live in a state where fertility coverage isn’t mandated, you may be able to purchase supplemental coverage at a higher cost.
Which State Has the Best Fertility Insurance Coverage?
According to Resolve, The National Infertility Association, several states currently mandate above-average fertility insurance coverage. California, Colorado, and New York all cover at least one round of IVF in addition to diagnostic services.
While you are researching your options for fertility insurance, consider adding a fertility supplement to your daily routine.
